The Effect of Melatonin on Early Postoperative Cognitive Decline in Elderly Patients Undergoing Hip Arthroplasty: A Randomized Controlled Trial
Yunxia Fan, Liang-xi Yuan, Muhuo Ji, Jianjun Yang, Da-peng Gao
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引用次数: 0
Abstract
Copyright © 2017 Wolters Kluwer rate POCD. Exogenous melatonin improves sleep quality in patients with primary sleep disorders and can improve cognitive dysfunction in adults with mild cognitive impairment. This prospective cohort study aimed to determine whether melatonin can ameliorate early POCD in elderly hip arthroplasty patients. The study included 139 American Society of Anesthesiologists grades I to III patients older than 65 years scheduled for hip arthroplasty with spinal anesthesia. Patients were randomized to receive either 1 mg oral melatonin or placebo daily 1 hour before bedtime 1 day before surgery and for another 5 consecutive days postoperatively. Subjective sleep quality, generalwell-being, postoperative fatigue, visual analog scale for pain, and cognitive function (using Mini Mental State Examination [MMSE]) were evaluated preoperatively and at days 1, 3, 5, and 7 postoperatively. Statistical analysis was performed using the SPSS 16.0 software forWindows (SPSS, Chicago, Ill), and P < 0.05 was considered to be statistically significant. The MMSE score in the melatonin group did not change during the 7 days of monitoring after surgery, but in the control group, the MMSE score decreased significantly at days 1, 3, and 5 after surgery when compared with its own preoperative value and with the melatonin group value for the corresponding date (P < 0.05). A significant postoperative impairment of subjective sleep quality (F statistic estimate of variation [F] = 7.95, P < 0.05), general well-being (F = 5.791, P < 0.05), and fatigue (F = 8.333, P > 0.05) was found in the control group when compared with the melatonin group. In conclusion, perioperative melatonin supplementation improved preoperative sleep quality, thus confirming that exogenous melatonin can improve early POCD. Further studies are required to evaluate the effects of comorbidities and medication usage on melatonin's role in improving cognitive dysfunction.
褪黑素对老年髋关节置换术患者术后早期认知能力下降的影响:一项随机对照试验
版权所有©2017威科集团费率POCD。外源性褪黑素可改善原发性睡眠障碍患者的睡眠质量,并可改善轻度认知障碍成人的认知功能障碍。这项前瞻性队列研究旨在确定褪黑激素是否可以改善老年髋关节置换术患者的早期POCD。该研究包括139名年龄大于65岁的美国麻醉医师协会分级为I至III级的患者,他们计划接受脊柱麻醉的髋关节置换术。患者在术前1天睡前1小时随机接受1毫克口服褪黑素或安慰剂,术后连续5天。主观睡眠质量、总体幸福感、术后疲劳、疼痛视觉模拟量表和认知功能(使用迷你精神状态检查[MMSE])在术前和术后第1、3、5和7天进行评估。采用SPSS 16.0软件(SPSS, Chicago, Ill)进行统计学分析,P < 0.05为差异有统计学意义。褪黑素组患者术后监测7 d内MMSE评分无变化,而对照组患者术后1、3、5 d MMSE评分与自身术前值及同期褪黑素组比较,均显著降低(P < 0.05)。与褪黑激素组相比,对照组术后主观睡眠质量(F统计方差估计[F] = 7.95, P < 0.05)、总体幸福感(F = 5.791, P < 0.05)和疲劳感(F = 8.333, P > 0.05)均出现显著下降。综上所述,围手术期补充褪黑激素可改善术前睡眠质量,从而证实外源性褪黑激素可改善早期POCD。需要进一步的研究来评估合并症和药物使用对褪黑素改善认知功能障碍的作用的影响。
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